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Fat plays major role in cancer deaths

Thousands of cases could be prevented each year, study finds. Excess weight may account for 14% of all cancer deaths in men and 20% in women.

April 23 — Losing weight could prevent approximately one of every six cancer deaths in the United States — more than 90,000 each year — according to a sweeping long-term study that links fat and cancer more convincingly than ever before.

Researchers spent 16 years evaluating 900,000 people who were cancer-free when the study began in 1982. They concluded that excess weight appears to account for 14 percent of all cancer deaths in men and 20 percent of those in women.

The study, published in The New England Journal of Medicine, was big enough to back up a fat connection not only in those cancers where it has been known for some time (e.g., breast, colon, uterus, etc.), but in eight where it hadn’t been widely documented, lead researcher Eugenia Calle said. Calle said she was surprised the link “really was the rule more than the exception.”

Irrefutable Evidence
The study is 10 times greater than the largest previous research on the topic. Top researchers in both cancer and obesity said the research virtually proves they are linked.

Dr. Donna Ryan, head of clinical research at the Pennington Biomedical Research Center in Baton Rouge, said: “Because of the magnitude and strength of the study, it’s irrefutable. It’s absolutely convincing. And therefore it’s frightening.”

Dr. Robert Mayer of Harvard Medical School and the Dana Farber Cancer Institute in Boston said it’s not certain whether one in five, six or seven cancers might be prevented or better treated if people lost weight, but “What’s clear is that large studies of this sort — and this is the biggest and best to date — show very clearly this is a major health problem in this country.”

The study by the American Cancer Society relied on the body mass index (BMI) using heights and weights reported by study participants. For the study, a BMI of 18.5 to 24.9 was considered normal. Those who were overweight (25 to 29.9) or obese (30 or over were all compared to the normal group, and statistical analysis was used to adjust for smoking and other risk factors.

Links to Numerous Cancers
Earlier studies have found that excess weight contributes to cancers of the breast and uterus, colon and rectum, kidney, esophagus and gall bladder. This one also linked it to cancers of the cervix and ovary, multiple myeloma, non-Hodgkins lymphoma, pancreas, liver, and, in men, the stomach and prostate. The researchers found no link between fat and brain, skin and bladder cancers.

The overall link is stronger in women than in men. There are two major reasons for that, according to the researchers: (a) More women are obese, and (b) Breast and uterine cancers play a big role in these findings, especially breast cancer since it’s so common.

Too much body fat can influence cancer and cancer mortality a number of ways. It increases the amount of estrogen in the blood, increasing the risk of breast cancer and other cancers of the female reproductive system. It also increases the risk of acid reflux, which can cause cancer of the esophagus. And it raises levels of insulin, prompting the body to create a hormone which causes cells to multiply.

Obesity also makes cancer harder to diagnose and treat. It’s harder to see or feel lumps and bumps, and some patients don’t fit into CAT scanners, Dr. Mayer said. They also may avoid regular doctor’s visits, “possibly because of their appearance or they just shy away from physicians.”

The researchers said attitudes must change about weight the way they did about smoking. They said communities, workplaces, schools and transportation all need to change to make it easier to both eat right and exercise. “We’ve developed a culture where you have to work really hard to eat right and exercise,” Calle said. “We’re kind of stacking the deck against ourselves.”

To break the cycle of weight gain and ill health, experts recommend avoiding fad diets in favor of reasonable plans to optimize nutrition and increase activity levels.

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